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NHCAA Comments on Proposed Changes to MLR Under Medicare Parts C & D

The Centers for Medicare and Medicaid Services (CMS) has proposed significant changes to how medical loss ratio is calculated and reported for Medicare Advantage and Part D plans. If made final, the rule would expand the definition of Quality Improvement Activities (QIA) to include fraud reduction activities, including fraud prevention, fraud detection, and fraud recovery. NHCAA submitted a letter of support.

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MITRE's Healthcare Anti-Fraud Academic Competition

The MITRE Healthcare Anti-Fraud Academic Competition seeks to discover talented individuals with innovative solutions to assist government and private healthcare payers reduce dollars lost to health care fraud. MITRE is recruiting inquisitive students at U.S.-based colleges and universities.

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Medical Identity Theft

The Office of Inspector General recently released some helpful information and resources on medial identity theft. View the OIG website for more details.

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DOJ Announces Opioid Fraud and Abuse Detection Unit, Followed by Large Drug Diversion Case

On August 2, 2017, Attorney General Jeff Sessions announced the formation of an Opioid Fraud and Abuse Detection Unit as a new Department of Justice (DOJ) pilot program to “utilize data to help combat the devastating opioid crisis that is ravaging families and communities across America.” The new unit will focus on identifying and prosecuting people who contribute to the nation’s prescription opioid fraud and abuse epidemic.

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